[Facilitators and barriers regarding end of life care at nursing homes: A focus group study]. / Dificultades y factores favorables para la atención al final de la vida en residencias de ancianos: un estudio con grupos focales.

AIM: To identify the facilitators and barriers experienced by professional related to end of life care in nursing homes. DESIGN: Descriptive qualitative research with phenomenological orientation, through content analysis. PLACEMENT: Nursing Homes at Primary Care District in Granada (Spain). PARTICIPANTS: Fifteen clinical professionals with, at least 6 months of experience in nursing homes, without specific background in palliative care. METHODS: Three focus groups were undertaken with professionals of different disciplines and nursing homes. Interviews were recorded and transcribed literally. An open and axial coding was performed to identify relevant categories. RESULTS: Professionals identified difficulties in the communication with families related to relatives' feelings of guilt, difficulty in understanding the deterioration of their relative, and addressing too late the issue of death. Regarding decision making, professionals recognized that they do not encourage participation of patients. Advance directives are valued as a necessary tool, but they do not contemplate implementing them systematically. Other difficulties that professionals highlighted are lack of coordination with other professionals, related to misunderstanding of patients' needs, as well as lack of training, and lack of material and human resources. Facilitators include relationships with primary care teams. CONCLUSION: It is necessary to improve communication among nursing homes professionals, families, patients and other health workers.

Dificultades y factores favorables para la atención al final de la vida en residencias de ancianos: un estudio con grupos focales / Facilitators and barriers regarding end of life care at nursing homes: A focus group study

OBJETIVO: Identificar las dificultades y factores favorables experimentados por los profesionales, relacionados con el final de la vida en las residencias de ancianos. DISEÑO: Estudio cualitativo descriptivo, desde una perspectiva fenomenológica mediante análisis del contenido. Emplazamiento: Residencias de ancianos del Distrito de Atención Primaria Granada (España). PARTICIPANTES: Quince profesionales asistenciales con un mínimo de 6 meses de experiencia en residencias y sin formación específica en cuidados paliativos. MÉTODOS: Se realizaron 3 grupos focales con profesionales de diferentes disciplinas y residencias. Las conversaciones fueron grabadas y transcritas literalmente. Se realizó una codificación abierta y axial para identificar las categorías más relevantes. RESULTADOS: Los profesionales identifican dificultades en la comunicación con las familias, relacionadas con sentimientos de culpa de los familiares, dificultad para comprender el deterioro, y un abordaje tardío del tema de la muerte. En cuanto a la toma de decisiones, los profesionales reconocen que no fomentan la participación de los pacientes. Las voluntades anticipadas son valoradas como una herramienta necesaria, pero no contemplan su implementación de manera sistemática. Otras dificultades que los profesionales destacan son la falta de coordinación con otros profesionales, relacionada con la falta de comprensión de las necesidades de los pacientes, así como la falta de formación y de recursos materiales y humanos. Como factor favorable, destacan las relaciones con los equipos de atención primaria. CONCLUSIÓN: Es necesario mejorar la comunicación entre los profesionales, las familias, los pacientes y otros trabajadores de la salud

AIM: To identify the facilitators and barriers experienced by professional related to end of life care in nursing homes. DESIGN: Descriptive qualitative research with phenomenological orientation, through content analysis. Placement: Nursing Homes at Primary Care District in Granada (Spain). PARTICIPANTS: Fifteen clinical professionals with, at least 6 months of experience in nursing homes, without specific background in palliative care. METHODS: Three focus groups were undertaken with professionals of different disciplines and nursing homes. Interviews were recorded and transcribed literally. An open and axial coding was performed to identify relevant categories. RESULTS: Professionals identified difficulties in the communication with families related to relatives' feelings of guilt, difficulty in understanding the deterioration of their relative, and addressing too late the issue of death. Regarding decision making, professionals recognized that they do not encourage participation of patients. Advance directives are valued as a necessary tool, but they do not contemplate implementing them systematically. Other difficulties that professionals highlighted are lack of coordination with other professionals, related to misunderstanding of patients' needs, as well as lack of training, and lack of material and human resources. Facilitators include relationships with primary care teams. CONCLUSION: It is necessary to improve communication among nursing homes professionals, families, patients and other health workers